86. Are You The Problem? How Women Physicians Can Change the Culture of Medicine

Hey Doc,

Are you the problem? Not you alone, but us. Women physicians.

Without realizing it, we uphold the very systems — patriarchy, sexism, racism — that keep us playing small. It shows up in the way we react when another woman asks for more, when we hesitate to negotiate, or when we discourage salary transparency, and when we are passing down outdated advice to younger women physicians.

The truth is: the system of medicine was built in a different era, for a different demographic — and those old rules still shape how we show up today.

This isn’t about blame. It’s about accountability. It’s about unlearning what we were taught, and replacing them with a culture that actually serves us.

In this episode you’ll hear:

• Why asking for more should be celebrated, not criticized
• The danger of believing negotiation is “unprofessional”
• Why pay transparency matters (and who really benefits when we stay silent)
• How to hold yourself and other women physicians accountable in a way that opens conversation instead of shutting it down

Doc, it’s time to stop shrinking yourself to fit outdated expectations. 

Take back your power. 

Ask. Negotiate. Advocate. 

And support other women when they do the same.

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Transcript

  📍 Hey Doc, I have a question for you. Are you the problem? And not just you, we, all of us as women physicians, are we part of the problem? And the problem is the thing that's keeping us down, the patriarchy, the racism, the all of it. Everything that is against us having power, believing that we have the power, exuding it, and being free, and feeling as though we have control over our lives and our careers.

Are we part of the problem? Are we holding ourselves back by the way that we think, the things that we do, how we interact with other female physicians, other women in general? I think this is a very important question to ask. Because you know, I've thought about this quite a bit, but very recently it's been coming up more frequently. So I was like, you know what? Let me do a podcast about this. And the most recent time it came up, it was a flavor of this entitled au pair. I give her X, Y, Z already, and can you believe she's already asking for more?

I am always fascinated by the fact that we are offended when young women ask for what they want, and then in the same breath are upset when we don't get what we think we deserve. Or we are upset that our male counterparts get X, Y, Z. And yes, there is patriarchy. Yes, there is sexism. Yes, there is racism. But one thing that we cannot ignore is that men often ask for what they want, whether or not they think they deserve it, whether or not they think they're qualified.

So one of my biggest things, you know this, is to encourage women and moms to ask for what they want, unapologetically, whether you think you deserve it or not, solely because you want it. Solely because you could.. "Let me see if they'll say yes, why not? The worst they can say is no."

So why is it when you have a young woman who is coming to this country, to basically have a good time. Let's be real, right? Yes, they are coming to take care of your children, but they're coming for an experience. Why do we get upset when she asks for more, when that's our goal too? That's what we want for ourselves. Or at least maybe we are not admitting that that's what we want. Maybe that's what it is. Like it's triggering to see this young woman taking this bold step that we can't or won't, or are too scared to take.

So I, you know, I said all that and I was just like, you know, let it be part of the cultural exchange that you learn to be bold, and learn to be unapologetic, and just ask. Like,

It doesn't have to mean that she's entitled,

that she doesn't appreciate what you are doing.

It doesn't have to mean any of that.

It just means that she saw something that she wanted and she asked for it.

So getting upset, like

How, how could she ask for this?

We are already giving her so much and...

that's like wasted energy.

Just say no.

If you really don't want to give her what she's asking for, if you've... like,

"No, we are at our limits."

"We are already providing all these things."

Just say no.

But I think it is something to be celebrated,

to be admired, to be learned from

when somebody is able to ask.

And... let me just say, of course there, there will be a ridiculous ask. It it may annoy you, it may be offensive the way that it was done or whatever. This is not to negate any negative feelings that may come from a situation like this, but the general consensus is How dare she? How dare she ask for this thing? Oh they're so entitled! Are they entitled? Sure they may be, but it's not just because they're asking for more.

And also, let me just go off on a tangent for a little bit. The reason that they're asking is because there are people that are giving it to them. They know that it is possible. If everybody said no, they would be like, Oh, it doesn't make sense. Nobody's gonna go for that. So, you are the problem as well if you are offering a $500 stipend, and an apartment, and free use of the car, with all expenses paid trip, and gym memberships, and we'll do whatever else, you are setting the expectation so that, Yeah. Well, my friend got this. Of course I'm gonna ask too. So again, are you the problem? Okay, that's off on the tangent.

So let's not get upset when these young women ask. And that takes me to the other situations, and they all revolve around money. Is this idea that we cannot and should not negotiate. I had one of my clients tell me this, that she was advised by one of her mentors that you shouldn't negotiate too much when you are going for a new job because it just looks bad and you know, it's so unprofessional, that they had this one person who kept going back and forth, and it was such a turn off. Who does that benefit? For you to believe that it is unprofessional to negotiate. Why would it be unprofessional? Do do you think it's unprofessional to negotiate when you are signing a new contract? Like who gave you that idea? It is the same mindset, right? What is the problem with asking? If you don't want to give it to me or you, you can't, just say no.

But this idea that it is frowned upon, it's not something we do, is particular, not just to medicine, but for women. Because we have their studies and stuff that women don't negotiate, but men do. They ask for what they want. And the way that our system works in capitalism, American capitalism, they have a range that they are willing to give. They're gonna give you the lowest one because they want the cheapest person. So we are leaving money on the table. And asking, negotiating, none of those things mean being a hard ass, like being a bitch, I'm gonna come in and I'm gonna stick it to them, and if they don't want it, doesn't mean any of that.

But in our minds, I think we equate those two things and it just adds to the, Oh, well that's not professional. If I ask for something, if I try to negotiate, they're gonna rescind the offer. That is a possibility. And I knew, you probably thought I was gonna say that's not gonna happen. But it can. They are telling you who they are. If you negotiate, if you use a lawyer, if you ask for this thing changed, and they say, well, no, we don't want you working here. That is not a place that you want to work, point blank period. Because it is showing you how they're going to move for the rest of your time there.

Anything that you need, so it's not just the amount of money at the beginning. It's your clinic schedule, it's getting another MA, it's paying for a scribe. They have set the expectation that you cannot ask for anything. We will give you what we think you deserve. And that's it. So it's a red flag. And it should not deter you from negotiating, from asking.

And the whole narrative about professionalism, it's often used in these situations as a surrogate for discrimination, right? When they say, Oh, well this behavior is unprofessional. It's only unprofessional for you. Like, if somebody else were to exhibit this exact same behavior, it would get a pass or it would even get celebrated. Don't fall for the trap. Negotiate. Ask for more money. Ask for a higher sign on bonus. Ask for more vacation. It doesn't always have to be strict dollars and cents. You know, ask for an extra MA. Ask for that AI scribe. I mean, if, uh, if places don't have AI scribes by now, you don't need to be working there. Don't go there.

Ask for whatever it is you need

to make it sustainable

and to make sure that you stay at this job.

Because it's a, it has to be a win-win.

The longer you stay, the less turnover they have.

It is expensive to onboard a physician.

It is time consuming and expensive. Real dollars and cents.

So you are doing them a favor by negotiating,

by asking for what you want to keep you there,

to have longevity in your career.

So it can even be presented in that way, you know, like, this is a win win. This will help you too. So asking, negotiating if it's done well, should not feel like a battle. It really shouldn't. That's like TV stuff.

So

When you are mentoring other women physicians, are you telling them, Oh, well, don't negotiate. It's, it's unprofessional. Don't, don't ask for too much. You know, when, when you go to a new locum site, just wait a little bit, you don't wanna seem too aggressive. If you start asking for stuff too early,

they're not gonna like it.

Are you the problem?

Because it's a culture, right? Like

we are in a culture of medicine,

and the culture has been set, and the culture was set a long time ago when the demographics were different

and it was not set to benefit us as women. So it is expected

that the culture would be ingrained in us,

and therefore it dictates how we move,

and how we treat other women

and our colleagues.

It's like, Are you telling your colleagues, your mentees coming up behind you some of this

outdated information about negotiating and asking?

It's important for us to evaluate what we think, and how we think, and where these ideas came from. Because another one that I see is the perpetuation of this idea that physicians should not discuss pay.

So there was a woman physician who was angry about physician salaries being discussed, because it was in the contract that you do not discuss pay and compensation. And she was like, Well, you know, he broke the rules. I just remember thinking, Why do you care? Don't you wanna know? It's only gonna benefit the both of you if we all share that information. We know if there's a huge discrepancy, we have negotiating power together. But she was like, He broke the rules. The rule, the contract says we do not we do not discuss our salary. That is the culture that has been ingrained in us and it only benefits the employer for the employees to not know what each other's making.

There should be transparency. And don't just assume that this is a private practice thing, BTWs. So I want you to look at yourself too if you work for corporate medicine. Because let me tell you, my job is a large, the largest private practice, but like corporate medicine in the country. And they did not have transparency with pay. It was not equitable. Even though they tell you the contracts are the same, everybody gets the same. It's graded by how many years you've been out. Nah. It's not true. And the only reason I know that, is because I discussed compensation with a colleague. But I guarantee you there are women there who, No, we don't discuss that. That's against the rules. They're part of the problem.

So if you feel called out doc. I, I'm, I'm sorry. Actually I'm not. Because

It's time for us to be the change.

It's time for us to take responsibility, radically,

have accountability for one another

as we try to change this culture of medicine

and society too.

Because like my first example was with these, these au pairs asking for what they want. So start with, You have to start with yourself.

Am I having a negative reaction to this woman asking for what she wants,

negotiating her contract,

discussing salary

because she's doing something wrong?

Or because it's been ingrained in me that this is not what we do?

And then who is that benefiting?

What is the actual harm in this woman advocating for herself? In this woman being empowered enough to decide what she wants and go for it?

So if you are listening and you're like, Well, no, I don't have a problem with any of those things. Excellent. Good. You just got to hear me go on my rant for how long has it been for 18 minutes for no reason. But these are conversations that we, we need to have and continue to have, so that we can, we can change things, we can move forward. Okay?

So the next time,

In the vein of accountability,

the next time you hear another woman physician spouting some of these ideas, and being upset that another woman

is asking for what she wants or discussing pay.

You know, you can, you can call her out. And call her out, has this negative like feel, right? Like get called out. It does not, it's the same thing with confrontation.

It doesn't have to be all that.

It could just be ,

That's an interesting take.

Tell me a little bit more about why you think that way.

You know, you start with curiosity.

Because she may have a reason that has nothing to do with anything that I'm talking about, but It opens the door

for constructive conversation

and actual changing of her mind.

Because if you come in hot, like, Well that's some bullshit. You don't like women, you should be ashamed of yourself. She's just gonna shut right down and that conversation is gonna go nowhere. Starting any conversation like this, any difficult conversation with curiosity, figuring out where this person's coming from, and then introducing a new idea, things that she probably didn't even think about, you know. That's, that's what I mean by call her out.

Because we have to hold each other accountable and make sure that we recognize that whatever discomfort, whatever angry feeling we may have, that that is learned behavior that needs to be unlearned for all of us to take back our power, to regain control of our lives and just be unapologetic. Yeah. I'm gonna ask. That's, that's all I want for you, doc. That's it. That is all I want.

So share this with another doc who needs to assess if she is the problem. You don't tell her it's a call out. Tell her it's a really great episode, and while you're at it, tell Apple that it's a really great episode, too, and write a review. Five stars, please. If you're on any other podcast platform, leave me a five star rating, share, subscribe, do all the things. It helps other physician moms find this podcast, hear these words. So that we can Mm. Be empowered together, right? We could change medicine. We could ask for what we want. We can laugh in the face of ridiculous requests from au pairs, but still be proud of them for asking. We can do all that, together, right?

So I'll see you on the next episode of Stethoscopes and Strollers.